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PCOS : Understanding the problems in treatment

Polycystic ovary syndrome (PCOS) is the most common female hormone disruption, affecting 5–10% of women in their reproductive years and is associated with 75% of all disorders of ovulation causing infertility.

It is best diagnosed using the Rotterdam criteria in which any 2 of the following 3 are sufficient to confirm the diagnosis:

The management of PCOS depends on the presenting symptoms. Whether these are excess body hair (hirsutism) or acne, oligo/amenorrhoea, or anovulatory infertility, the first-line treatment for the overweight or frankly obese must be loss of weight. For infertile anovulatory patients, clomiphene citrate is the first-line medication of choice but letrozole is challenging for this position. Metformin is much less successful than clomifene for this purpose.

Low-dose FSH therapy is the second-line of treatment but laparoscopic ovarian drilling is also successful particularly for normal weight women with high LH levels. Most women whose cause of infertility is purely anovulatory PCOS will successfully conceive with one of these treatments but for those who have failed (and probably have an additional factor)

IVF is a relatively successful ‘last resort’ treatment.

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